POS0676 THE CHALLENGE OF IDENTIFYING DIFFICULT-TO-TREAT AXIAL SPONDYLOARTHRITIS IN CLINICAL PRACTICE: RESULTS FROM LA PAZ-SPA COHORT
Authors: M. Juárez, D. Benavent, V. Navarro-Compán, M. Novella-Navarro, D. Peiteado, A. Villalba, I. Monjo, L. Nuño, A. Balsa, C. Plasencia
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Despite pharmacological options for axial spondyloarthritis (axSpA) have increased recently, still one out of three patients do not achieve the recommended target [1]. <h3>Objectives</h3> To determine patient and disease characteristics in patients with "difficult to treat" (D2T) axSpA in comparison with "good responders" (GR) and to identify predictive factors of D2T-axSpA. <h3>Methods</h3> Data from an observational prospective cohort recruiting consecutively patients diagnosed of axSpA initiating the first bDMARD from La Paz Hospital between 2004-2019 were analysed. Patients who fulfilled one of the following definitions were included: i) D2T: failure to at least two b/tsDMARDs, ii) GR: patients remaining treated with the first bDMARD for at least 3 years or stopping it due to disease control. Clinical characteristics, laboratory tests, concomitant treatment and disease activity measures prior to starting the first bDMARD and after 6 months were collected. Also, b/tsDMARD courses were registered. Chi-square or Fisher test were used for qualitative variables and unpaired t-student was used for quantitative variables. Univariable and multivariable logistic binary regression analyses were used. <h3>Results</h3> Out of 101 patients included, 41.6% were classified as D2T and 58.4% as GR. When initiating the first bDMARD, compared with GR, D2T patients had statistically significant shorter symptom duration and more frequently enthesitis, inflammatory bowel disease (IBD), concomitant NSAIDs, smoking habit and comorbidities (hypertension, dyslipidemia, depression or anxiety and fibromyalgia), all p&lt;0.05 (Table 1). However, no significant differences were found in age, sex, BMI, subtype of axSpA, dactylitis, peripheral arthritis, uveitis, psoriasis, concomitant csDMARDs, diabetes mellitus or cardiopathy. While no differences were found for disease activity composite measures (ASDAS, BASDAI) and CRP or ESR, D2T patients had greater scores in BASDAI questions for pain and morning stiffness, TJC, PtGA and PhyGA. After 6 months of starting the first bDMARD, the scores for all disease activity measures, including ASDAS, BASDAI, CRP and ESR were significantly higher in D2T patients. Reasons for b/tsDMARDs discontinuation in D2T patients are shown in Figure 1. In multivariable analysis, smoking habit (OR=6.5, p&lt;0.05), HLAB27 negative (OR=5.8, p&lt;0.05), enthesitis (OR=48.1, p&lt;0.01), baseline TJC (OR=1.2, OR&lt;0.05) and baseline PhyGA (OR=1.05, p&lt;0.05) were independently associated with D2T. <h3>Conclusion</h3> Compared with GR, patients with D2T-axSpA have more frequently poor prognostic factors for therapy response (smoking and HLAB27 negative) and worse response to first bDMARD after 6 months. Further strategies to implement recommendations for not smoking and control of comorbidities should be implemented. <h3>Reference</h3> [1]Smolen JS, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018. <h3>Disclosure of Interests</h3> Manuel Juárez: None declared, Diego Benavent Speakers bureau: Janssen, Roche, Galapagos, Grant/research support from: Novartis, Abbvie, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie and Novartis, Marta Novella-Navarro Speakers bureau: Galapagos, UCB, Lilly and Janssen, Grant/research support from: UCB, Lilly and Janssen, Diana Peiteado: None declared, Alejandro Villalba: None declared, Irene Monjo Speakers bureau: Roche, Novartis, UCB, Gedeon Richter, Consultant of: Roche, Laura Nuño: None declared, Alejandro Balsa Speakers bureau: Pfizer, Abbvie, Lilly, Galapagos, BMS, Sandoz, Nordic Pharma, Gebro, Roche, Sanofi, UCB, Consultant of: Pfizer, Abbvie, Lilly, Galapagos, BMS, Nordic Pharma, Sanofi, UCB, Grant/research support from: Pfizer, Abbvie, BMS, Nordic Pharma, Gebro, Roche, UCB, Chamaida Plasencia Speakers bureau: Pfizer, Abbvie, Lilly, Sandoz, Sanofi, Biogen, Roche, Novartis, Grant/research support from: Pfizer and Abbvie.